TY - JOUR
T1 - Yttrium-90 Radioembolization of Unresectable Intrahepatic Cholangiocarcinoma
T2 - Long-Term Follow-up for a 136-Patient Cohort
AU - Gupta, Aakash N.
AU - Gordon, Andrew C.
AU - Gabr, Ahmed
AU - Kalyan, Aparna
AU - Kircher, Sheetal M.
AU - Mahalingam, Devalingam
AU - Mulcahy, Mary F.
AU - Merkow, Ryan P.
AU - Yang, Anthony D.
AU - Bentrem, David J.
AU - Caicedo-Ramirez, Juan C.
AU - Riaz, Ahsun
AU - Thornburg, Bartley
AU - Desai, Kush
AU - Sato, Kent T.
AU - Hohlastos, Elias S.
AU - Kulik, Laura
AU - Benson, Al B.
AU - Salem, Riad
AU - Lewandowski, Robert J.
N1 - Funding Information:
The authors thank Vanessa L. Gates, Karen Grace, Krystina Salzig, Melissa Williams, and Carlene del Castillo for their compassionate care of patients and dedication to clinical research.
Funding Information:
This study was not supported by any funding.
Publisher Copyright:
© 2022, Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).
PY - 2022/8
Y1 - 2022/8
N2 - Purpose: Unresectable intrahepatic cholangiocarcinoma (ICC) signifies a poor prognosis with limited treatment options beyond systemic chemotherapy. This study’s purpose was to evaluate the safety, efficacy, and potential for downstaging to resection of yttrium-90 (Y90) radioembolization for treatment of unresectable ICC. Materials and Methods: From 2004 to 2020, 136 patients with unresectable ICC were treated with radioembolization at a single institution. Retrospective review was performed of a prospectively collected database. Outcomes were (1) biochemical and clinical toxicities, (2) local tumor response, (3) time to progression, and (4) overall survival (OS) after Y90. Univariate/multivariate survival analyses were performed. A subgroup analysis was performed to calculate post-resection recurrence and OS in patients downstaged to resection after Y90. Results: Grade 3+ clinical and biochemical toxicities were 7.6% (n = 10) and 4.9% (n = 6), respectively. Best index lesion response was complete response in 2 (1.5%), partial response in 42 (32.1%), stable disease in 82 (62.6%), and progressive disease in 5 (3.8%) patients. Median OS was 14.2 months. Solitary tumor (P < 0.001), absence of vascular involvement (P = 0.009), and higher serum albumin (P < 0.001) were independently associated with improved OS. Eleven patients (8.1%) were downstaged to resection and 2 patients (1.5%) were bridged to transplant. R0-resection was achieved in 8/11 (72.7%). Post-resection median recurrence and OS were 26.3 months and 39.9 months, respectively. Conclusion: Y90 has an acceptable safety profile and high local disease control rates for the treatment of unresectable ICC. Downstaging to resection with > 3 years survival supports the therapeutic role of Y90 for unresectable ICC. Level of Evidence: Level 3, single-arm single-center cohort study.
AB - Purpose: Unresectable intrahepatic cholangiocarcinoma (ICC) signifies a poor prognosis with limited treatment options beyond systemic chemotherapy. This study’s purpose was to evaluate the safety, efficacy, and potential for downstaging to resection of yttrium-90 (Y90) radioembolization for treatment of unresectable ICC. Materials and Methods: From 2004 to 2020, 136 patients with unresectable ICC were treated with radioembolization at a single institution. Retrospective review was performed of a prospectively collected database. Outcomes were (1) biochemical and clinical toxicities, (2) local tumor response, (3) time to progression, and (4) overall survival (OS) after Y90. Univariate/multivariate survival analyses were performed. A subgroup analysis was performed to calculate post-resection recurrence and OS in patients downstaged to resection after Y90. Results: Grade 3+ clinical and biochemical toxicities were 7.6% (n = 10) and 4.9% (n = 6), respectively. Best index lesion response was complete response in 2 (1.5%), partial response in 42 (32.1%), stable disease in 82 (62.6%), and progressive disease in 5 (3.8%) patients. Median OS was 14.2 months. Solitary tumor (P < 0.001), absence of vascular involvement (P = 0.009), and higher serum albumin (P < 0.001) were independently associated with improved OS. Eleven patients (8.1%) were downstaged to resection and 2 patients (1.5%) were bridged to transplant. R0-resection was achieved in 8/11 (72.7%). Post-resection median recurrence and OS were 26.3 months and 39.9 months, respectively. Conclusion: Y90 has an acceptable safety profile and high local disease control rates for the treatment of unresectable ICC. Downstaging to resection with > 3 years survival supports the therapeutic role of Y90 for unresectable ICC. Level of Evidence: Level 3, single-arm single-center cohort study.
KW - Intrahepatic cholangiocarcinoma
KW - Radioembolization
KW - Yttrium-90
UR - http://www.scopus.com/inward/record.url?scp=85132380839&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85132380839&partnerID=8YFLogxK
U2 - 10.1007/s00270-022-03183-2
DO - 10.1007/s00270-022-03183-2
M3 - Article
C2 - 35732931
AN - SCOPUS:85132380839
SN - 0174-1551
VL - 45
SP - 1117
EP - 1128
JO - Cardiovascular and Interventional Radiology
JF - Cardiovascular and Interventional Radiology
IS - 8
ER -
